OBJECTIVE: To evaluate different patterns of coronal deformity secondary to ankylosing spondylitis (AS), to propose relevant treatment strategies, and to assess efficacy of asymmetrical pedicle subtraction osteotomy (APSO).
METHODS: Coronal deformity was defined as coronal Cobb angle over 20º or coronal balance distance (CBD) more than 3 cm. 65 consecutive AS patients with concomitant coronal and sagittal deformity who underwent PSO were included. The average follow-up time was 40.4 months. Radiographic evaluation included coronal Cobb angle and CBD. Furthermore, sagittal parameters were used to assess magnitude and maintenance of kyphosis correction.
RESULTS: Based on curve characteristics, coronal deformity caused by AS included four different radiologic patterns: Pattern I: lumbar scoliosis; Pattern II: C-shaped thoracolumbar curve; Pattern III: trunk shift without major curve; Pattern IV: proximal thoracic scoliosis. APSO was performed for patients in Pattern I to III while conventional PSO was applied for patients in Pattern IV. Significant improvement in all the sagittal parameters were noted in 65 patients without obvious correction loss at the last follow-up. Besides, significant and sustained correction of coronal mal-alignment was identified in 59 APSO-treated patients. Rod fracture occurred in four cases and revision surgery was performed for one case.
CONCLUSIONS: According to radiologic manifestations, coronal deformity caused by AS could be categorized into four patterns. APSO proved to be a feasible and effective procedure for correction of Pattern I to III patients. Coronal deformity pattern, apex location, sagittal profile of lumbar spine and preoperative hip function should be considered for osteotomy level selection in APSO.

Collaborative and innovative educational approaches are essential to building nurses\' competencies in responding to healthcare challenges and to enhance high-quality nursing practice. Nurses are increasingly learning in various contexts, and thus, the understanding and organising of collaborative learning needs further exploration.
To describe collaborative learning in nursing practice and education from the point of view of nurses, involved as students and teachers in master\'s education in nursing.
Qualitative study using semi-structured focus groups involving 33 nurses as master\'s students and teachers from Estonia and Norway. The data were analysed using inductive content analysis.
The essence of collaborative learning in the context of nursing practice and education was identified as the aggregation of diverse learners\' skills and reflections while working towards shared aims. This fostered the development of workplace competencies, professional attitudes, and personal growth. Organising collaborative learning requires careful planning and synchronisation between clinical and educational organisations.
Collaborative learning is an inclusive method, aiding nurses at different phases of their career to gain knowledge and enhance their soft skills, and potentially reducing professional hierarchies. Further research is needed to develop methods for evaluating the outcomes of collaborative learning.

We present a theoretical investigation of electron heat current in asymmetrical length armchair graphene nanoribbon (AGNR) heterostructures with vacancies, focusing on the topological states (TSs). In particular, we examine the 9-7-9 AGNR heterostructures where the TSs are well-isolated from the conduction and valence subbands. This isolation effectively mitigates thermal noise of subbands arising from temperature fluctuations during charge transport. Moreover, when the TSs exhibit an orbital off-set, intriguing electron heat rectification phenomena are observed, primarily attributed to inter-TS electron Coulomb interactions. To enhance the heat rectification ratio (ηQ), we manipulate the coupling strengths between the heat sources and the TSs by introducing asymmetrical lengths in the 9-AGNRs. This approach offers control over the rectification properties, enabling significant enhancements. Additionally, we introduce vacancies strategically positioned between the heat sources and the TSs to suppress phonon heat current. This arrangement effectively reduces the overall phonon heat current, while leaving the TSs unaffected. Our findings provide valuable insights into the behavior of electron heat current in AGNR heterostructures, highlighting the role of topological states, inter-TS electron Coulomb interactions, and the impact of structural modifications such as asymmetrical lengths and vacancy positioning. These results pave the way for the design and optimization of graphene-based devices with improved thermal management and efficient control of electron heat transport.

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Bilateral presentation of multiple evanescent white dot syndrome (MEWDS) is a rare occurrence. We report a case of bilateral multiple evanescent white dot syndrome in a young female patient with asymmetrical manifestation. She presented with sudden onset of right eye central blurring of vision and dyschromatopsia. Fundus examination however showed bilateral multiple grey-white intra-retinal punctate lesions with an asymmetrical manifestation of the swollen optic disc and foveal granularity over the right. Spectral Domain Optical Coherence Tomography (SD-OCT) showed the presence of juxta foveal subretinal fluid and disrupted inner segment-outer segment (IS-OS) junction over the right eye. The patient had a spontaneous complete recovery within six weeks\' time.

Positive airway pressure that dynamically changes with breathing, and clearance of anatomical dead space are the key mechanisms of noninvasive respiratory support with nasal high flow (NHF). Pressure mainly depends on flow rate and nare occlusion. The hypothesis is that an increase in asymmetrical occlusion of the nares leads to an improvement in dead-space clearance resulting in a reduction in re-breathing. Clearance was investigated with volumetric capnography in an adult upper-airway model, which was ventilated by a lung simulator with entrained carbon dioxide (CO2) at respiratory rates (RR) of 15-45 min-1 and at 18 min-1 with chronic obstructive pulmonary disease (COPD) breathing patterns. Clearance was assessed at NHF of 20-60 L/min with a symmetrical interface (SI) and an asymmetrical interface (AI). CO2 kinetics visualized by infrared spectroscopy and mathematical modeling were used to study the mechanisms of clearance. At a higher RR (35 min-1) and NHF of 60 L/min, clearance in the upper airway was significantly higher with the AI when compared with the SI (29.64 ± 9.96%, P < 0.001), as opposed to at a lower RR (15 min-1) (1.40 ± 6.25%, P > 0.05), (means ± SD). With COPD breathing, clearance by NHF was reduced but significantly improved with the AI by 45.93% relative to the SI at NHF 20 L/min (P < 0.0001). The maximum pressure achieved with the AI was 6.6 cmH2O and NHF was 60 L/min at the end of expiration. Pressure differences between nasal cavities led to the reverse flow observed in the optical model. Asymmetrical NHF increases dead-space clearance by reverse flow through the choanae and accelerates purging of expired gas via the less occluded nare.NEW & NOTEWORTHY The asymmetrical interface generated reverse flow in the nasal cavities and across the choana, which led to unidirectional purging of expired gas from the upper airways. This accelerated the clearance of anatomical dead space and reduced re-breathing while increased resistance to flow resulted in higher positive end-expiratory pressure (PEEP). These findings are relevant to patients with elevated respiratory rates or with expiratory flow limitations where dead-space clearance by NHF can be substantially reduced.

The current study reports a comparative investigation for the nonlinear optical (NLO) response for some symmetric and asymmetric molecular configurations. The designed compounds are featuring a similar 2,7-bis(phenyl ethynyl)cyclopentaaceanthrylene core connected to different terminal donor and acceptor moieties such as dimethylamine, methoxy, nitro and ethene-tricarbonitrile groups based on three topologies, \"D-π-D\" (1-2), \"A-π-A\" (3-4) and \"D-π-A\" (5-8). A comparative analysis of these symmetrically and asymmetrically substituted chromophores is done to investigate the effect of different terminal groups on their NLO response, optical and charge transfer properties. The asymmetric compounds display larger first hyperpolarizability amplitudes (β//) than those of the symmetric compounds where a β// amplitude as large as 1851 × 10-30 esu is calculated for asymmetric compound 6. Interestingly, the average second hyperpolarizabilities (γ) for symmetric compound 4 have been calculated to be 16, 096 × 10-36 esu and for asymmetric counterpart compound 6 it is found to be 23, 162 × 10-36 esu using M06/6-311G* methodology. Our findings were also inline with experimental observations of Mathews et al. (Mathews, S.J., et al., 2007. Optics Communications, 280, 206-212), where they also experimentally determined the larger third-order susiptibility for asymmetric phthalocyanine (Pc3) than their symmetric counterparts. Additionally, the NLO polarizabilities of all the compounds have also been compared with a typical donor-acceptor molecule of p-NA to specify the comparison of designed compounds. TD-DFT studies have shown that the higher β and γ values were found for asymmetric compounds owing to their lower transition energies and larger trasition dipole moments. The depiction of molecular orbitals and electrostatic potentials have shown more efficient intramolecular charge transfer (ICT) for asymmetric compounds leading to the robust NLO response. Thus, a systematic comparison of the NLO polarizabilities and other electronic properties of our designed symmetric and asymmetric compounds shows that symmetry based designing of NLO compounds are very crucial to get robust NLO response properties.

We report a rare entity of distinctly asymmetrical rheumatoid arthritis (RA) in a 71-year-old Chinese lady with a history of cervical radiculopathy secondary to trauma sustained during childhood. The joints on the side of the paresis were spared from severe clinical and radiological manifestations of RA. We review the plausible mechanisms that could explain the link between neurological impairment and rheumatoid joint involvement.

UNASSIGNED: Evaluation of asymmetrical and symmetrical horizontal strabismus surgery as regards efficacy and postoperative lateral gaze incomitance.
UNASSIGNED: This prospective comparative interventional case series study included 40 patients of age more than 3 years with alternating horizontal strabismus. Patients were divided according to the type of horizontal deviation into esotropia and exotropia groups, which were further subdivided into asymmetrical and symmetrical subgroups in each type. The surgery was defined as symmetrical procedure if the surgery was done on the same muscle in the two eyes and it was defined as asymmetric in recess-resect procedures in one eye, and three horizontal muscles surgery. Preoperative and postoperative measurements were done in primary position, right, and left gaze using alternate prism cover test and hand-held orthopedic goniometer.
UNASSIGNED: At the end of follow-up period, a statistically insignificant difference (P value = 0.8057) was present in the success rate between the asymmetrical and symmetrical subgroups of esotropia (90 and 86.67%, respectively) and it was 100% in both exotropia subgroups. Lateral gaze incomitance results were different between esotropia and exotropia subgroups. In esotropia, a statistically significant difference was reported at 1 month (0.009), which became insignificant at 6 months (0.077) and 12 months (0.077) between asymmetrical and symmetrical subgroups. In exotropia subgroups, there was a statistically insignificant difference in lateral gaze incomitance at 1, 6, and 12 months (P = 1).
UNASSIGNED: Asymmetrical procedure had the same efficacy and success rate of symmetrical procedure for the correction of concomitant horizontal deviations in primary gaze without persistent postoperative lateral gaze incomitance, especially in exotropia.
UNASSIGNED: NCT04199286.

Bilateral hip dislocation is a rare injury and asymmetrical hip dislocations are even very rare entities. We are reporting two cases of bilateral asymmetrical hip dislocations with associated acetabulum fractures. Mechanism of injury in first case was fall from height and in other case road traffic accident. Associated injuries were midshaft femur fracture and sciatic nerve (Peroneal part). Anterior hip dislocation in both cases is reduced closely but posterior hip dislocation in both cases relocated openly due to ipsilateral femur fracture in first case and unstable hip in second case. Acetabulum fractures fixed with reconstruction plate. Postoperative recovery of patient was uneventful except sciatic nerve injury (Peroneal part) lead to foot drop that is supported with ankle foot arthrosis.